Cervical Spine Chordoma With Tracheal and Vascular Invasion: A Case Report.

Chordomas are rare, locally aggressive tumors from notochordal remnants, often involving critical neurovascular structures. We present a case of a tracheostomy patient with metastatic cervical chordoma causing significant airway obstruction and vascular encasement, leading to failed attempts to modify her existing tracheostomy, recurrent hemorrhage, and ultimately death. We review the literature on airway-compromising chordomas, detail the multidisciplinary management of this patient's airway, and propose considerations for adapting the difficult airway algorithm in cases involving critical airway compromise. This case highlights the challenges of managing advanced disease and the need for evolving airway management protocols tailored to patients with known critical airways.